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Spierling Bagsic SR, Fortmann AL, San Diego ERN, Soriano EC, Belasco R, Sandoval H, Bastian A, Padilla Neely OM, Talavera L, Leven E, Evancha N, Philis-Tsimikas A. Outcomes of the Dulce Digital-COVID Aware (DD-CA) discharge texting platform for US/Mexico border Hispanic individuals with diabetes. Diabetes Res Clin Pract 2024; 210:111614. [PMID: 38484985 PMCID: PMC11062488 DOI: 10.1016/j.diabres.2024.111614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Hispanic individuals have higher type 2 diabetes (T2D) prevalence, poorer outcomes, and are disproportionately affected by COVID-19. Culturally-tailored, diabetes educational text messaging has previously improved HbA1c in this population. METHODS During the pandemic, hospitalized Hispanic adults with T2D (N = 172) were randomized to receive Dulce Digital-COVID Aware ("DD-CA") texting platform upon discharge plus diabetes transition service (DTS) or DTS alone. DD-CA includes diabetes educational messaging with additional COVID-safe messaging (e.g., promoting masking; social distancing; vaccination). FINDINGS Among adults with poorly-controlled diabetes (Mean HbA1c = 9.6 ± 2.2 %), DD-CA did not reduce 30- or 90-day readmissions compared to standard care (28 % vs 15 %, p = .06; 37 % vs 35 %, p = .9, respectively). However, the improvement in HbA1c was larger among those in the DD-CA compared to DTS at 3 months (n = 56; -2.69 % vs. -1.45 %, p = .0496) with reduced effect at 6 months (n = 64; -2.03 % vs -0.91 %, p = .07). Low follow-up completion rates and the addition of covariates (to control for baseline group differences that existed despite randomization) impacted statistical power. INTERPRETATION During the pandemic, DD-CA offered an alternative digital approach to diabetes and COVID education and support for a high-risk Hispanic population and achieved trends toward improvement in glycemic control despite relatively low engagement and not reducing hospital readmissions.
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Affiliation(s)
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Emily Rose N San Diego
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Rebekah Belasco
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Alessandra Bastian
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Olivia M Padilla Neely
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Laura Talavera
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Eric Leven
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Nicole Evancha
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
| | - Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego CA, Rip Road, New York, NY, United States
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Coiner S, Hernandez A, Midyette P, Patel B, Talley M. Nurse-Led Care Coordination in a Transitional Clinic for Uninsured Patients With Diabetes. Prof Case Manag 2024:01269241-990000000-00016. [PMID: 38557562 DOI: 10.1097/ncm.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE/OBJECTIVES The purpose of this article is to inform the reader of the practice of the registered nurse care coordinator (RNCC) within an interprofessional, nurse-led clinic serving uninsured diabetic patients in a large urban city. This clinic serves as a transitional care clinic, providing integrated diabetes management and assisting patients to establish with other primary care doctors in the community once appropriate. The clinic uses an interprofessional collaborative practice (IPCP) model with the RNCC at the center of patient onboarding, integrated responsive care, and clinic transitioning. PRIMARY PRACTICE SETTING Interprofessional, nurse-led clinic for uninsured patients with diabetes. FINDINGS/CONCLUSIONS Interprofessional models of care are strengthened using a specialized care coordinator. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Care coordination is a key component in case management of a population with chronic disease. The RNCC, having specialized clinical expertise, is an essential member of the interdisciplinary team, contributing a wide range of resources to assist patients in achieving successful outcomes managing diabetes. Transitional care coordination, moving from unmanaged to managed diabetes care, is part of a bundled health care process fundamental to this clinic's IPCP model. In a transitional clinic setting, frequent interaction with patients through onboarding, routine check-ins, and warm handoff helps support and empower the patient to be engaged in their personal health care journey.
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Affiliation(s)
- Sarah Coiner
- Sarah Coiner, DNP, RN-BC, CNL, CNE, CDCES, is an instructor at The University of Alabama at Birmingham (UAB) School of Nursing (SON) and a certified clinical nurse leader. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Alison Hernandez, PhD, MPH, RN, is a nurse clinic manager at the UAB PATH Clinic. She received a PhD in Public Health at Umea University, Sweden, and completed her BSN at UAB. Her doctoral research focused on nurses' performance in rural Guatemala. Her career interest is developing the nursing profession's role in addressing health inequities
- Paula Midyette, MSN, CCNS, CCRN-K, CNE, CDCES, is an adjunct didactic instructor at UAB SON and is a certified adult health clinical nurse specialist. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Bela Patel, DNP, CRNP, NP-C, is a certified adult-gerontology primary care nurse practitioner. Currently, she works as an assistant professor at UAB SON and maintains her faculty practice as the lead nurse practitioner at the PATH Clinic that specializes in providing care to the indigent population with diabetes
- Michele Talley, PhD, ACNP-BC, FNAP, FAANP, FAAN, is Professor, Associate Dean for Clinical and Global Partnerships at UAB SON, and Director of the UAB PATH Clinic. Her focus is on transforming care of diabetes using innovative models
| | - Alison Hernandez
- Sarah Coiner, DNP, RN-BC, CNL, CNE, CDCES, is an instructor at The University of Alabama at Birmingham (UAB) School of Nursing (SON) and a certified clinical nurse leader. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Alison Hernandez, PhD, MPH, RN, is a nurse clinic manager at the UAB PATH Clinic. She received a PhD in Public Health at Umea University, Sweden, and completed her BSN at UAB. Her doctoral research focused on nurses' performance in rural Guatemala. Her career interest is developing the nursing profession's role in addressing health inequities
- Paula Midyette, MSN, CCNS, CCRN-K, CNE, CDCES, is an adjunct didactic instructor at UAB SON and is a certified adult health clinical nurse specialist. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Bela Patel, DNP, CRNP, NP-C, is a certified adult-gerontology primary care nurse practitioner. Currently, she works as an assistant professor at UAB SON and maintains her faculty practice as the lead nurse practitioner at the PATH Clinic that specializes in providing care to the indigent population with diabetes
- Michele Talley, PhD, ACNP-BC, FNAP, FAANP, FAAN, is Professor, Associate Dean for Clinical and Global Partnerships at UAB SON, and Director of the UAB PATH Clinic. Her focus is on transforming care of diabetes using innovative models
| | - Paula Midyette
- Sarah Coiner, DNP, RN-BC, CNL, CNE, CDCES, is an instructor at The University of Alabama at Birmingham (UAB) School of Nursing (SON) and a certified clinical nurse leader. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Alison Hernandez, PhD, MPH, RN, is a nurse clinic manager at the UAB PATH Clinic. She received a PhD in Public Health at Umea University, Sweden, and completed her BSN at UAB. Her doctoral research focused on nurses' performance in rural Guatemala. Her career interest is developing the nursing profession's role in addressing health inequities
- Paula Midyette, MSN, CCNS, CCRN-K, CNE, CDCES, is an adjunct didactic instructor at UAB SON and is a certified adult health clinical nurse specialist. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Bela Patel, DNP, CRNP, NP-C, is a certified adult-gerontology primary care nurse practitioner. Currently, she works as an assistant professor at UAB SON and maintains her faculty practice as the lead nurse practitioner at the PATH Clinic that specializes in providing care to the indigent population with diabetes
- Michele Talley, PhD, ACNP-BC, FNAP, FAANP, FAAN, is Professor, Associate Dean for Clinical and Global Partnerships at UAB SON, and Director of the UAB PATH Clinic. Her focus is on transforming care of diabetes using innovative models
| | - Bela Patel
- Sarah Coiner, DNP, RN-BC, CNL, CNE, CDCES, is an instructor at The University of Alabama at Birmingham (UAB) School of Nursing (SON) and a certified clinical nurse leader. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Alison Hernandez, PhD, MPH, RN, is a nurse clinic manager at the UAB PATH Clinic. She received a PhD in Public Health at Umea University, Sweden, and completed her BSN at UAB. Her doctoral research focused on nurses' performance in rural Guatemala. Her career interest is developing the nursing profession's role in addressing health inequities
- Paula Midyette, MSN, CCNS, CCRN-K, CNE, CDCES, is an adjunct didactic instructor at UAB SON and is a certified adult health clinical nurse specialist. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Bela Patel, DNP, CRNP, NP-C, is a certified adult-gerontology primary care nurse practitioner. Currently, she works as an assistant professor at UAB SON and maintains her faculty practice as the lead nurse practitioner at the PATH Clinic that specializes in providing care to the indigent population with diabetes
- Michele Talley, PhD, ACNP-BC, FNAP, FAANP, FAAN, is Professor, Associate Dean for Clinical and Global Partnerships at UAB SON, and Director of the UAB PATH Clinic. Her focus is on transforming care of diabetes using innovative models
| | - Michele Talley
- Sarah Coiner, DNP, RN-BC, CNL, CNE, CDCES, is an instructor at The University of Alabama at Birmingham (UAB) School of Nursing (SON) and a certified clinical nurse leader. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Alison Hernandez, PhD, MPH, RN, is a nurse clinic manager at the UAB PATH Clinic. She received a PhD in Public Health at Umea University, Sweden, and completed her BSN at UAB. Her doctoral research focused on nurses' performance in rural Guatemala. Her career interest is developing the nursing profession's role in addressing health inequities
- Paula Midyette, MSN, CCNS, CCRN-K, CNE, CDCES, is an adjunct didactic instructor at UAB SON and is a certified adult health clinical nurse specialist. She holds a faculty practice as a nursing care coordinator at the UAB PATH Clinic and is a certified diabetes care and education specialist
- Bela Patel, DNP, CRNP, NP-C, is a certified adult-gerontology primary care nurse practitioner. Currently, she works as an assistant professor at UAB SON and maintains her faculty practice as the lead nurse practitioner at the PATH Clinic that specializes in providing care to the indigent population with diabetes
- Michele Talley, PhD, ACNP-BC, FNAP, FAANP, FAAN, is Professor, Associate Dean for Clinical and Global Partnerships at UAB SON, and Director of the UAB PATH Clinic. Her focus is on transforming care of diabetes using innovative models
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Giorda CB, Picariello R, Tartaglino B, Nada E, Romeo F, Costa G, Gnavi R. Hospitalisation for herpes zoster in people with and without diabetes: A 10-year-observational study. Diabetes Res Clin Pract 2024; 210:111603. [PMID: 38460790 DOI: 10.1016/j.diabres.2024.111603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024]
Abstract
AIMS This study explores the association between Herpes Zoster (HZ) hospitalizations and diabetes in Piedmont, Italy from 2010 to 2019. Focusing on the burden of HZ hospitalizations in diabetic and non-diabetic groups, it aims to identify risk factors in diabetics to enhance prevention strategies. METHODS In a two-phase study, we first compared age-standardized HZ hospitalization rates between diabetic and non-diabetic individuals from 2010 to 2019. We then examined hospitalization risk factors for HZ within a diabetic patient cohort managed by regional diabetes clinics. RESULTS Of 3,423 HZ hospitalizations in 2010-2019, 17.9 % (613 cases) were diabetic patients, who exhibited higher hospitalization rates (15.9 to 6.0 per 100,000) compared to non-diabetese individuals. Among diabetics subjects risk factors for HZ hospitalization included age over 65, obesity (BMI > 30), and poor glycemic control (HbA1c > 8.0 %). These patients had a 40 % increased rehospitalization risk and a 25 % higher risk of severe complications, such as stroke and myocardial infarction, post-HZ. CONCLUSIONS Diabetes markedly increases HZ hospitalization rates, rehospitalization, and complication risks. These findings underscore the need for preventive strategies, especially improved glycemic control among high-risk diabetic patients, to inform public health policies and clinical practices aimed at mitigating HZ's impact on this population.
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Affiliation(s)
- Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy.
| | | | | | - Elisa Nada
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Francesco Romeo
- Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy; Department of Public Health, University of Torino, Torino, Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy
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4
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O'Connor MJ, Ding X, Hernandez C, Hubacz L, Church RJ, O'Connor L. A Pilot Trial of Continuous Glucose Monitoring Upon Emergency Department Discharge Among People With Diabetes Mellitus. Endocr Pract 2024; 30:122-127. [PMID: 37952581 DOI: 10.1016/j.eprac.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE People with diabetes mellitus, particularly those with limited access to longitudinal care, frequently present to the emergency department (ED). Continuous glucose monitoring (CGM) has been shown to improve outcomes in ambulatory settings, so we hypothesized that it would be beneficial if initiated upon ED discharge. METHODS We randomized adults with diabetes who were seen in the ED for hypo- or hyperglycemia to either 14 days of flash CGM or care coordination alone. All participants were scheduled to follow up in our diabetes specialty clinic. Outcomes included clinic attendance, the 3-month change in hemoglobin A1c, and repeat ED utilization. RESULTS We recruited 30 participants, including 13 with newly diagnosed diabetes. All but one (97%) had type 2 diabetes. We found no significant difference between the CGM (n = 16) and control (n = 14) groups in terms of clinic attendance (75 vs 64%, P = .61) or repeat ED utilization (31 vs 50%, P = .35), although our power was low. The absolute reduction in A1c was greater in the CGM group (5.2 vs 2.4%, P = .08). Among newly diagnosed participants for whom we had data, 7 out of 7 in the CGM group had a follow-up A1c under 7% compared to 1 out of 3 in the control group (P = .03). Over 90% of patients and providers found the CGM useful. CONCLUSIONS Our data demonstrate the feasibility of starting CGM in the ED, a valuable setting for engaging difficult-to-reach patients. Our pilot study was limited by its small sample size, however, as recruitment in the ED can be challenging.
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Affiliation(s)
- Mark J O'Connor
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Xinyi Ding
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Camila Hernandez
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Lisa Hubacz
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Richard J Church
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Laurel O'Connor
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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5
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Galindo RJ, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S295-S306. [PMID: 38078585 PMCID: PMC10725815 DOI: 10.2337/dc24-s016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Masuda H, Iwashima F, Ishiyama D, Nakajima H, Kimura Y, Otobe Y, Suzuki M, Koyama S, Tanaka S, Kojima I, Yamada M. Effect of Exercise Therapy on Incident Admission in Patients with Type 2Diabetes Mellitus Undergoing Inpatient Diabetes Self-manageme ntEducation and Support. Curr Diabetes Rev 2024; 20:e211123223677. [PMID: 37990899 DOI: 10.2174/0115733998269490231106190128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Exercise therapy is the key to preventing admission of patients with type 2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercise therapy on patients with T2DM undergoing inpatient diabetes self-management education and support (IDSMES). OBJECTIVE This study investigated whether exercise therapy influenced the incidence of admission after discharge in patients with T2DM undergoing IDSMES. METHODS This retrospective cohort study included patients with T2DM who underwent IDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study. The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosed between June 2011 and May 2013 were categorized as the non-exercise therapy program group, while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapy program group. Outcomes were incident diabetes-related and all-cause admissions within 1 year of discharge. Multiple logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the exercise therapy program's impact on the outcomes. RESULTS Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissions and 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed a significant association of the exercise therapy program with incident diabetes-related and allcause admissions [OR: 0.22 (95% CI: 0.08-0.59) and 0.44 (95% CI: 0.22-0.86), respectively]. CONCLUSION Exercise therapy programs significantly lowered the incidences of diabetes-related and all-cause admissions. This indicates that implementing exercise therapy during hospitalization may be important for preventing admissions of patients with T2DM receiving IDSMES.
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Affiliation(s)
- Hiroaki Masuda
- Department of Rehabilitation, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Fumiko Iwashima
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173- 0015, Japan
| | - Daisuke Ishiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Hideki Nakajima
- Department of Rehabilitation, Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, 33-1 Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yosuke Kimura
- Health and Sports Technology Course, College of Science and Engineering, Kanto Gakuin University, 1- 50-1 Mutsuura, Kanazawa-ku, Yokohama, 236-8501, Japan
| | - Yuhei Otobe
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, 3-7-30 Habikino, Habikino-city, Osaka, 583-8555, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Shingo Koyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Shu Tanaka
- Major of Physical Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo, 144-8535, Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
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Ata F, Khan AA, Khamees I, Iqbal P, Yousaf Z, Mohammed BZM, Aboshdid R, Marzouk SKK, Barjas H, Khalid M, El Madhoun I, Bashir M, Kartha A. Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis. Ann Med 2023; 55:533-542. [PMID: 36745515 PMCID: PMC9904305 DOI: 10.1080/07853890.2023.2175031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. METHODS We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. RESULTS We included 922 patients with a median age of 35 years (25-45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1-4.8), and the median DKA resolution time was 18 h (10.5-29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. CONCLUSIONS/INTERPRETATION This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Adeel Ahmad Khan
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Khamees
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Phool Iqbal
- Department of Medicine, New York Medical College/Metropolitan Hospital Center, New York, NY, USA
| | - Zohaib Yousaf
- Department of Medicine, Reading Hospital-Tower Health, West Reading, PA, USA
| | | | - Reham Aboshdid
- Department of Geriatrics, Hamad Medical Corporation, Doha, Qatar
| | | | - Haidar Barjas
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Madiha Khalid
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ihab El Madhoun
- Department of Nephrology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Bashir
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Anand Kartha
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Weill Cornell Medicine, Doha, Qatar
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8
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Gale J, Varndell W, James S, Perry L. Unscheduled emergency department presentations with diabetes: Identifying high risk characteristics. Australas Emerg Care 2023; 26:205-210. [PMID: 36528482 DOI: 10.1016/j.auec.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Unscheduled emergency department (ED) presentation by patients with diabetes has seldom been examined. This study aimed to determine the frequency and associated characteristics of presentations in this population. METHODS Using a prospective cross-sectional design, data were collected from patients with diabetes presenting and/or admitted to a tertiary metropolitan hospital in New South Wales, Australia (December 2016-September 2017). A screening interview including brief measures of cognitive and executive function, and clinical details from healthcare records were utilised; details around unscheduled presentations within 90 days were extracted. Independent associations with ED presentation were determined. RESULTS Unscheduled ED presentations were common; 35.4% had at least one within 90 days, and for 20.1% this occurred within 28 days. The screening tool contributed little towards identifying risk of unscheduled presentation. Those attending any community or outpatient follow-up appointment within the first 28 (OR 0.42, 95% CI 0.23-0.76; p = 0.004) or 90 days (OR 0.25; 0.13-0.47; p < 0.001) from the index presentation were less likely to present within that same period. CONCLUSIONS Findings indicated the magnitude of unscheduled ED presentation, care complexity and the value of targeted and timely follow-up. Alternative service support may help maintain and improve diabetes self-management and will require effectiveness and cost-effectiveness evaluation.
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Affiliation(s)
- Julie Gale
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wayne Varndell
- Prince of Wales Hospital, Randwick, New South Wales, Australia; University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Steven James
- University of the Sunshine Coast, Petrie, Queensland, Australia; University of Melbourne, Parkville, Victoria, Australia.
| | - Lin Perry
- Prince of Wales Hospital, Randwick, New South Wales, Australia; University of Technology Sydney, Ultimo, New South Wales, Australia
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Rubin DJ, Maliakkal N, Zhao H, Miller EE. Hospital Readmission Risk and Risk Factors of People with a Primary or Secondary Discharge Diagnosis of Diabetes. J Clin Med 2023; 12:jcm12041274. [PMID: 36835810 PMCID: PMC9961750 DOI: 10.3390/jcm12041274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Hospital readmission among people with diabetes is common and costly. A better understanding of the differences between people requiring hospitalization primarily for diabetes (primary discharge diagnosis, 1°DCDx) or another condition (secondary discharge diagnosis, 2°DCDx) may translate into more effective ways to prevent readmissions. This retrospective cohort study compared readmission risk and risk factors between 8054 hospitalized adults with a 1°DCDx or 2°DCDx. The primary outcome was all-cause hospital readmission within 30 days of discharge. The readmission rate was higher in patients with a 1°DCDx than in patients with a 2°DCDx (22.2% vs. 16.2%, p < 0.01). Several independent risk factors for readmission were common to both groups including outpatient follow up, length of stay, employment status, anemia, and lack of insurance. C-statistics for the multivariable models of readmission were not significantly different (0.837 vs. 0.822, p = 0.15). Readmission risk of people with a 1°DCDx was higher than that of people with a 2°DCDx of diabetes. Some risk factors were shared between the two groups, while others were unique. Inpatient diabetes consultation may be more effective at lowering readmission risk among people with a 1°DCDx. These models may perform well to predict readmission risk.
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Affiliation(s)
- Daniel J. Rubin
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, 3322 N. Broad Street, Suite 205, Philadelphia, PA 19140, USA
- Correspondence: ; Tel.: +1-215-707-4746; Fax: +1-215-707-5599
| | - Naveen Maliakkal
- Department of Medicine, Temple University Hospital, Philadelphia, PA 19140, USA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, 3322 N. Broad Street, Suite 205, Philadelphia, PA 19140, USA
| | - Eli E. Miller
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, 3322 N. Broad Street, Suite 205, Philadelphia, PA 19140, USA
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10
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S267-S278. [PMID: 36507644 PMCID: PMC9810470 DOI: 10.2337/dc23-s016] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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11
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Arroba AI, Aguilar-Diosdado M. Special Issue “The Prevention, Treatment, and Complications of Diabetes Mellitus”. J Clin Med 2022; 11:jcm11185305. [PMID: 36142952 PMCID: PMC9501071 DOI: 10.3390/jcm11185305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ana I. Arroba
- Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cádiz, Spain
- Department of Endocrinology and Metabolism, Hospital Puerta del Mar, 11009 Cádiz, Spain
| | - Manuel Aguilar-Diosdado
- Research Unit, Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cádiz, Spain
- Department of Endocrinology and Metabolism, Hospital Puerta del Mar, 11009 Cádiz, Spain
- School of Medicine, Cadiz University (UCA), Ana de Viya 21, 11009 Cadiz, Spain
- Correspondence:
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12
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Effect of Algoplaque Hydrocolloid Dressing Combined with Nanosilver Antibacterial Gel under Predictive Nursing in the Treatment of Medical Device-Related Pressure Injury. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9756602. [PMID: 35860183 PMCID: PMC9293497 DOI: 10.1155/2022/9756602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022]
Abstract
It was aimed at the clinical value of predictive nursing and Algoplaque hydrocolloid dressing (AHD) combined with nanosilver antibacterial gel in treating medical device-related pressure injury (MDRPI). 100 patients, who underwent surgery in Chongqing Qijiang District People's Hospital from February 2019 to February 2020, were selected as the research objects and were randomly divided into the experimental group (50 cases) and the control group (50 cases). For the characterization test, a nanosilver antibacterial gel was created first. Patients in both groups received predictive nursing, but those in the experimental group received AHD and nanosilver antibacterial gel, and those in the control group received gauzes. MDRPI incidence, pressed skin injury severity, comfort level, clothing changes, nursing satisfaction, and other factors were all compared. The particle size of the nanosilver gel was 45-85 nm, with a relatively homogeneous distribution with the medium size, according to the findings. The incidence of MDRPI in the experimental group was lower than that in the control group significantly (6% vs. 30%, P < 0.05). The degree of injury of pressured skin in the experimental group was milder than that in the control group (P < 0.05), the degree of comfort and nursing satisfaction was higher in the experimental group than in the control group (P < 0.05), and dressing change count was lower than that in the control group (P < 0.05). In the treatment of MDRPI, predictive nursing and AHD using nanosilver antibacterial gel showed high clinical application value.
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13
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Jenssen C, Pietsch C. Stationäre Patienten mit der Nebendiagnose Diabetes mellitus: klinische Relevanz. DIABETOLOGE 2022. [PMCID: PMC9045025 DOI: 10.1007/s11428-022-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In deutschen Krankenhäusern werden jährlich etwa 3 Mio. Patienten mit Diabetes stationär behandelt, davon 93 % nicht wegen, sondern mit dieser Erkrankung. In einzelnen Fachabteilungen liegt bei bis zu 40 % der Patienten die Nebendiagnose Diabetes vor. Sie haben oft eine relevante Komorbidität und im Vergleich zu Krankenhauspatienten ohne Diabetes eine längere stationäre Verweildauer, entwickeln deutlich häufiger Komplikationen und müssen öfter kurzfristig wieder aufgenommen werden. In dieser Übersicht wird die klinische Relevanz der Nebendiagnose Diabetes mellitus für Krankenhauspatienten besprochen.
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Affiliation(s)
- Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
| | - Cristine Pietsch
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland GmbH, 15344 Strausberg, Deutschland
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14
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Rubin DJ, Gogineni P, Deak A, Vaz C, Watts S, Recco D, Dillard F, Wu J, Karunakaran A, Kondamuri N, Zhao H, Naylor MD, Golden SH, Allen S. The Diabetes Transition of Hospital Care (DiaTOHC) Pilot Study: A Randomized Controlled Trial of an Intervention Designed to Reduce Readmission Risk of Adults with Diabetes. J Clin Med 2022; 11:1471. [PMID: 35329797 PMCID: PMC8949063 DOI: 10.3390/jcm11061471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022] Open
Abstract
Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk adults with diabetes. This was a non-blinded pilot randomized controlled trial (RCT) that compared usual care (UC) to DiaTOHC at a safety-net hospital. The primary outcome was all-cause 30-day readmission. Between 16 October 2017 and 30 May 2019, 93 patients were randomized. In the intention-to-treat (ITT) population, 14 (31.1%) of 45 DiaTOHC subjects and 15 (32.6%) of 46 UC subjects had a 30-day readmission, while 35.6% DiaTOHC and 39.1% UC subjects had a 30-day readmission or ED visit. The Intervention−UC cost ratio was 0.33 (0.13−0.79) 95%CI. At least 93% of subjects were satisfied with key intervention components. Among the 69 subjects with baseline HbA1c >7.0% (53 mmol/mol), 30-day readmission rates were 23.5% (DiaTOHC) and 31.4% (UC) and composite 30-day readmission/ED visit rates were 26.5% (DiaTOHC) and 40.0% (UC). In this subgroup, the Intervention−UC cost ratio was 0.21 (0.08−0.58) 95%CI. The DiaTOHC Program may be feasible and may decrease combined 30-day readmission/ED visit risk as well as healthcare costs among patients with HbA1c levels >7.0% (53 mmol/mol).
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Affiliation(s)
- Daniel J. Rubin
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
| | - Preethi Gogineni
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
| | - Andrew Deak
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (A.D.); (S.W.); (D.R.); (F.D.)
| | - Cherie Vaz
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
| | - Samantha Watts
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (A.D.); (S.W.); (D.R.); (F.D.)
| | - Dominic Recco
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (A.D.); (S.W.); (D.R.); (F.D.)
| | - Felicia Dillard
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (A.D.); (S.W.); (D.R.); (F.D.)
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19140, USA;
| | - Abhijana Karunakaran
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
| | - Neil Kondamuri
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA;
| | - Mary D. Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Shaneisha Allen
- Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (P.G.); (C.V.); (A.K.); (N.K.); (S.A.)
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15
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Kozioł M, Towpik I, Żurek M, Niemczynowicz J, Wasążnik M, Sanchak Y, Wierzba W, Franek E, Walicka M. Predictors of Rehospitalization and Mortality in Diabetes-Related Hospital Admissions. J Clin Med 2021; 10:jcm10245814. [PMID: 34945110 PMCID: PMC8704926 DOI: 10.3390/jcm10245814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
The risk factors of rehospitalization and death post-discharge in diabetes-related hospital admissions are not fully understood. To determine them, a population-based retrospective epidemiological survey was performed on diabetes-related admissions from the Polish national database. Logistic regression models were used, in which the dependent variables were rehospitalization due to diabetes complications and death within 90 days after the index hospitalization. In 2017, there were 74,248 hospitalizations related to diabetes. A total of 11.3% ended with readmission. Risk factors for rehospitalization were as follows: age < 35 years; male sex; prior hospitalization due to acute diabetic complications; weight loss; peripheral artery disease; iron deficiency anemia; kidney failure; alcohol abuse; heart failure; urgent, emergency, or weekend admission; length of hospitalization; and hospitalization in a teaching hospital with an endocrinology/diabetology unit. Furthermore, 7.3% of hospitalizations resulted in death within 90 days following discharge. Risk factors for death were as follows: age; neoplastic disease with/without metastases; weight loss; coagulopathy; alcohol abuse; acute diabetes complications; heart failure; kidney failure; iron deficiency anemia; peripheral artery disease; fluid, electrolytes, and acid–base balance disturbances; urgent or emergency and weekend admission; and length of hospitalization. We concluded that of all investigated factors, only hospitalization within an experienced specialist center may reduce the frequency of the assessed outcomes.
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Affiliation(s)
- Milena Kozioł
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Iwona Towpik
- Department of Internal Diseases, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
| | - Michał Żurek
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jagoda Niemczynowicz
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Małgorzata Wasążnik
- Department of Analyses and Strategies, Polish Ministry of Health, 00-952 Warsaw, Poland; (M.K.); (M.Ż.); (J.N.); (M.W.)
| | - Yaroslav Sanchak
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
| | - Waldemar Wierzba
- Satellite Campus in Warsaw, University of Humanities and Economics in Lodz, 01-513 Warsaw, Poland;
| | - Edward Franek
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 02-106 Warsaw, Poland
| | - Magdalena Walicka
- Department of Internal Diseases, Endocrinology and Diabetology Central, Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland; (Y.S.); (E.F.)
- Department of Human Epigenetics, Mossakowski Medical Research Institute, 02-106 Warsaw, Poland
- Correspondence:
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